Is a new pandemic looming?: What we know so far about monkeypox

The coronavirus pandemic is not over yet, and a new virus is already causing uncertainty: monkeypox.

Is a new pandemic looming?: What we know so far about monkeypox

The coronavirus pandemic is not over yet, and a new virus is already causing uncertainty: monkeypox. The first confirmed cases have also been in Germany for a few days. There are already around 100 worldwide. Is a new pandemic imminent? The most important questions and answers.

What is special about the current monkeypox cases in Europe?

Monkeypox has been known since 1958. The first human case of monkeypox infection was recorded in 1970 in the Democratic Republic of the Congo. Monkeypox is endemic in parts of Africa, with small outbreaks occurring again and again. There was also a monkeypox outbreak in the United States in 2003, caused by prairie dogs imported from Ghana. The virus recently appeared sporadically in Europe, for example in Great Britain in 2018, 2019 and 2021. These cases were always related to trips to Africa, contact with travelers returning or contaminated materials.

However, now, for the first time in Europe, chains of infection from monkeypox are occurring with no known connection to West or Central Africa. "In the past, the spread of monkeypox outbreaks was limited," says virologist Stephan Becker from the University of Marburg. Chains of infection between people are unusual and must be closely monitored.

Is the number of monkeypox cases increasing worldwide?

The number of confirmed, suspected and probable cases of monkeypox has increased at least tenfold since 1970. One reason could be the decline in vaccination against the human smallpox virus (variola virus), which is closely related to the monkeypox virus. After smallpox was eradicated in 1980, vaccination against it was discontinued in the early 1980s. Researchers suspect that another reason for the increasing spread is deforestation, armed conflicts and population migration in Africa, which means that people are increasingly coming into contact with forest animals.

However, the exact animal source of the virus is unknown. The pathogen was first detected in monkeys in a Danish laboratory, hence the name monkeypox. But monkeys are considered false hosts - experts suspect that the virus actually circulates in squirrels and rodents.

Is there a monkeypox pandemic now?

The virologist Jonas Schmidt-Chanasit from the Bernhard Nocht Institute for Tropical Medicine in Hamburg told Deutschlandfunk that a pandemic was not to be feared. Monkey pox is very difficult to transmit, since infection occurs via mucous membrane contact. He therefore assumes that the outbreak of the disease can be contained. The virologist Gerd Sutter from the Ludwig Maximilians University in Munich made a similar statement: "We do not have to fear a new pandemic," he told the "Zeit". However, Fabian Leendertz, founding director of the Helmholtz Institute for One Health (HIOH) in Greifswald, spoke of an epidemic, i.e. a temporally and locally limited increased occurrence of the disease: "I would call this an epidemic, but it is very unlikely that this epidemic will last a long time."

How is monkeypox transmitted?

Transmission from animal to human is possible, according to the RKI often through contact with infected animals or animal blood and secretions, through eating infected monkey meat and droplet infection. Transmission of monkeypox between humans is considered rare. So far, only chains of infection from six to nine people have been observed. Members of the household of an infected person and anyone who comes into contact with infected people in the healthcare system are at increased risk of infection. "You can become infected through close physical contact with an infected person. The rash, body fluids (such as liquid, pus or blood from skin lesions) and scab are particularly contagious," writes virologist Sandra Cisek, Professor of Virology in Frankfurt, on Twitter. But the saliva can also be infectious if the patient has “corresponding lesions” in the mouth. Virologist Becker from the University of Marburg estimates that at least the transmission does not appear to be carried out by aerosols. "Then the pattern of propagation would be different."

Are homosexual men particularly at risk?

In the cases currently recorded, the majority, albeit not exclusively, affect men who have had sexual contact with other men. "Currently, the risk exposures seem to be predominantly sexual contacts between men," says the Federal Ministry of Health. "Places of exposure to the cases that have become known in Germany so far were party events, including on Gran Canaria (Spain) and in Berlin, where sexual acts occurred." The virus currently seems to be spreading mainly between homosexual or bisexual men, says virologist Becker.

However, the UN organization Unaids warned against stigmatizing the virus infection, which could “quickly undermine the fight against the epidemic”. While a large proportion of monkeypox cases confirmed to date affect gay, bisexual or other men who have sex with men, the disease can be transmitted through close contact with an infected person and "hence affects anyone".

When did the first case appear in Europe?

On May 7, a case of monkeypox was confirmed in the UK in a traveler returning from Nigeria. On May 19, the Bundeswehr Institute for Microbiology also detected a case of monkeypox in Germany.

How is an infection detected?

As with the corona virus and other pathogens, the detection is carried out with a sample of the person concerned using a so-called PCR test. If monkeypox viruses are present, their genetic material is specifically multiplied in a special device and can then be easily detected.

What are the symptoms of monkeypox?

The symptoms include: sudden onset of fever, severe headache, back pain, sore throat, cough, and often also swollen lymph nodes. A typical smallpox rash that spreads from the face to the body is also typical. Blindness and disfiguring scars rarely occur as permanent damage.

How dangerous is monkeypox?

According to health authorities, the circulating variant of the monkeypox virus usually causes only mild symptoms, but can also have severe courses. Two variants of the pathogen are known: According to Clemens Wendtner, chief physician of infectiology at the Munich Clinic Schwabing, the milder, West African variant leads to a mortality rate of around one percent, especially in children under 16 years of age. "But you have to keep in mind that these data from Africa are not necessarily transferrable to the healthcare system in Europe or the USA. Mortality would be lower here. This is a disease that I don't think has the potential to massively affect the population endanger." The mortality for the second, Central African variant is given as about ten percent.

All samples genetically analyzed so far were the West African pathogen variant, including the first patient in Munich. According to the RKI, all age groups and genders are equally susceptible.

What are the treatment options?

The drug Tecovirimat, which is effective against smallpox, cowpox and monkeypox, has been approved in the EU since January. According to the RKI, the treatment is particularly suitable for immunocompromised people, but is not yet widely available.

Is there a vaccine against monkeypox?

The classic smallpox vaccination also protects against monkeypox, since the viruses are very similar. The effectiveness should be at least 85 percent. The protection of a smallpox vaccination is probably lifelong. However, vaccination was discontinued in the early 1980s after the human smallpox virus was eradicated. However, older people who have received the vaccination should also be protected from monkeypox.

The vaccine Imvanex against smallpox (variola virus) for adults, which contains a modified smallpox virus, has been approved in the EU since 2013. It is not approved for the prevention of monkeypox in the EU. It is a third-generation vaccine that is less likely to cause side effects than traditional smallpox vaccines. According to studies on animals, its protective effect is probably similar to that of the classic smallpox vaccine. The WHO points out that this vaccine is not available nationwide. They want to convene experts to discuss possible vaccination recommendations.

Who should be vaccinated against monkeypox?

The European Center for Disease Prevention and Control (ECDC) recommends vaccination for close contacts at high risk (after risk-benefit assessment) for infection with monkeypox, if a suitable vaccine is approved in the country concerned. According to the Federal Ministry of Health, whether smallpox vaccination is recommended for contact persons and risk groups in Germany is still the subject of technical clarification. Apparently enough vaccine is available: "We have so much stock in Germany of the classic pox virus vaccine, a live vaccine, that the entire population could be vaccinated," says virologist Sutter.

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